Lifestyle Treatments as Important as Medications in Managing Obesity in Kids, Teens

Pharmacotherapies paired with lifestyle treatments were linked with the greatest short-term weight reduction in kids and teens with obesity, a systematic review and network meta-analysis showed.

Treatment with the GLP-1 receptor agonist semaglutide (Wegovy) plus counseling was associated with the largest body mass index (BMI) reduction (mean difference -8.31, 95% CI -12.33 to -4.28) and BMI z score reduction (mean difference -1.80, 95% CI -2.39 to -1.21), reported Bjorn Tam, PhD, of Hong Kong Baptist University, and colleagues in JAMA Pediatrics.

While semaglutide with counseling “emerged as the most potent intervention … this estimate comes from a single trial with relatively few participants,” the authors noted. As a result, they graded the certainty of evidence for this comparison as moderate.

Overall, Tam and colleagues examined a variety of interventions and comparators across 42 randomized trials:

• Lifestyle treatments — counseling, health behavior and lifestyle treatment (HBLT), and intensive HBLT (at least 26 hours)
• Pharmacological interventions — GLP-1 receptor agonists (liraglutide [Saxenda], semaglutide, dulaglutide [Trulicity], and exenatide [Byetta]) and other medications (orlistat [Alli], phentermine-topiramate [Qsymia], and metformin)
• Combination therapies — HBLT, intensive HBLT, or counseling with pharmacotherapy

More than 350 million people ages 5 to 14 years and 390 million people ages 15 to 24 years are projected to have overweight or obesity by 2050. In the U.S. alone, an estimated 17 million adolescents and young adults have been found to be eligible for GLP-1 receptor agonist treatment, though many lack insurance or a routine place for healthcare.

The increasing prevalence of obesity is linked to serious comorbidities, such as type 2 diabetes, cardiovascular disease, psychosocial distress, and others, Tam and colleagues noted.

“The profound health consequences and alarming trajectory of this epidemic underscore the urgent need for effective prevention and intervention strategies,” they wrote. However, “direct head-to-head comparisons of structured HBLT (by intensity), various pharmacotherapies (both FDA approved and off-label), and combined therapeutic strategies are scarce.”

In this study, pharmacotherapy plus lifestyle treatment “demonstrated the greatest efficacy across all adiposity-related outcomes,” they added. Moreover, all medications were more effective with lifestyle treatment compared with the same medications alone.

“Our analysis … suggests that lifestyle treatment was essential and should form the backbone of any pediatric obesity treatment plan,” they noted.

HBLT as monotherapy was also associated with substantial decreases in BMI (mean difference -3.85, 95% CI -4.91 to -2.80) and BMI z score (mean difference -0.89, 95% CI -1.17 to -0.61) versus no structured weight management plan. “Notably, these decreases were larger than those achieved by any of the individual pharmacotherapies included in our network when used as monotherapy (liraglutide and metformin),” Tam and colleagues pointed out.

For this systematic review and network meta-analysis, Tam and colleagues searched Embase, Central, PsycInfo, and PubMed from inception to June 17, 2025. They included 42 randomized trials, most of which (57%) were conducted in North America. The trials comprised 3,835 participants, with a mean age of 14.5 years. Nearly 60% of participants were female.

Looking at secondary outcomes, semaglutide plus counseling was associated with the largest decrease in waist circumference (mean difference -16.70 cm, 95% CI -31.57 to -1.83), while metformin with intensive HBLT showed the largest reduction in fat mass (standardized mean difference [SMD] -2.53, 95% CI -3.97 to -1.09), though Tam and colleagues noted that intensive HBLT monotherapy was also tied to a robust reduction (SMD -2.19, 95% CI -3.04 to -1.33).

For lean mass, exenatide with HBLT was linked to a significant loss (mean difference -4.30 kg, 95% CI -8.33 to -0.27), as was metformin alone (mean difference -2.00 kg, 95% CI -3.99 to -0.01).

Limitations of the study included that findings for newer drugs like GLP-1 agonists and phentermine-topiramate relied on only a few trials with small sample sizes, and that age was not identified as a significant treatment modifier, Tam and colleagues noted.

Inherent heterogeneity remained regarding components, duration, and intensity of lifestyle programs, as well as medication dosages, “potentially influencing outcome magnitudes,” they added, and most of the trials were short to medium duration (6 months to 1 year).